It seems, that the author has good intentions towards solving problems for patients with severe unsolved chronic physical and/or a nervous system illnesses. But naming (tagging) his desires to elevate them as "Pivots" doesn't make sense: since the word doesn't exist as is... ! A pivotal decision-making strategy is another way to express his desires, entirely... and should be used here, instead. So the work is about trying to Make the best decision when you're in pain and there is no professional-doctor's help available to you as a patient, suffering pain for a long time, to help you solve them with you and for you. And the author's idea in this situation: is to find solace within your family/friends' circle or perhaps, meditating... So the book is pacifying, but not practical or helpful. To me, at least.